Does gaze anxiety predict actual gaze avoidance and is it more informative than social anxiety?

BACKGROUND AND OBJECTIVES

In recent years eye-tracking studies have provided converging evidence that socially anxious individuals avoid looking at other people's faces in social situations. In addition to these objective measures, the Gaze Anxiety Rating Scale (GARS) has increasingly been used as a self-report measure of gaze avoidance. However, extant results concerning its predictive validity were inconsistent. Moreover, no study has considered social anxiety and gaze anxiety together to examine their relative contributions to actual gaze behavior.

METHODS

To address these two questions, eye-tracking data collected from 81 female students during the initial 6 min of a face-to-face conversation with a female confederate were analyzed. Gaze anxiety and social anxiety were measured via the GARS and the Leibowitz Social Anxiety Scale.

RESULTS

The results revealed that gaze anxiety was associated with reduced face gaze while speaking. Social anxiety was not only associated with decreased face gaze during speaking, but also across the initial conversation. Moreover, there was no evidence that gaze anxiety made an additional contribution to social anxiety in predicting face gaze behavior.

LIMITATIONS

This study examined face gaze instead of eye gaze. Additionally, the self-report data were not collected on the same day as the eye-tracking data.

CONCLUSIONS

The findings indicate that, in a community sample, gaze anxiety does predict actual gaze behavior during a face-to-face initial encounter, but social anxiety is a stronger predictor.

Social anxiety is related to reduced face gaze during a naturalistic social interaction

BACKGROUND

Social anxiety has long been related to reduced eye contact, and this feature is seen as a causal and a maintaining factor of social anxiety disorder. The present research adds to the literature by investigating the relationship between social anxiety and visual avoidance of faces in a reciprocal face-to-face conversation, while taking into account two aspects of conversations as potential moderating factors: conversational role and level of intimacy.

METHOD

Eighty-five female students (17-25 years) completed the Leibowitz Social Anxiety Scale and had a face-to-face getting-acquainted conversation with a female confederate. We alternated conversational role (talking versus listening) and manipulated intimacy of the topics (low versus high). Participants' gaze behavior was registered with Tobii eye-tracking glasses. Three dependent measures were extracted regarding fixations on the face of the confederate: total duration, proportion of fixations, and mean duration.

RESULTS

The results revealed that higher levels of social anxiety were associated with reduced face gaze on all three measures. The relation with total fixation duration was stronger for low intimate topics. The relation with mean fixation duration was stronger during listening than during speaking.

CONCLUSION

The results highlight the importance of studying gaze behavior in a naturalistic social interaction.

Associations between Autonomic and Endocrine Reactivity to Stress in Adolescence: Related to the Development of Anxiety?

Internalizing disorders in adolescence have been associated with disturbances in autonomic and endocrine functioning. Because the prefrontal cortex and the limbic system play a central role in regulating both the autonomic and the endocrine systems, their joint functioning is hypothesized to provide information about the potential development of internalizing symptoms throughout adolescence, notably in the preclinical stage. This hypothesis was tested in a sample of 198 adolescents from the general population. Heart rate variability (HRV) and skin conductance levels (SCLs) were measured before, during, and after a public speaking task. These autonomic parameters were associated with cortisol response to the task in the complete sample as well as in low- and high-anxiety adolescents separately. Self-reported social anxiety, low HRV, and high SCL recovery values were predictive of cortisol response. Importantly, in low-anxiety adolescents, only HRV during the task predicted the cortisol response, whereas, in their highly anxious peers, both HRV and SCL were strongly associated with this response. In the latter finding, age was a prominent factor. Additional analyses supported the idea that the interaction of autonomic and endocrine reactivity is subject to natural development. These findings provide evidence that adolescence might be a period of highly interactive emotional–neurobiological development, particularly with respect to the development of stress management skills.

Volume of subcortical brain regions in social anxiety disorder: mega-analytic results from 37 samples in the ENIGMA-Anxiety Working Group

There is limited convergence in neuroimaging investigations into volumes of subcortical brain regions in social anxiety disorder (SAD). The inconsistent findings may arise from variations in methodological approaches across studies, including sample selection based on age and clinical characteristics. The ENIGMA-Anxiety Working Group initiated a global mega-analysis to determine whether differences in subcortical volumes can be detected in adults and adolescents with SAD relative to healthy controls. Volumetric data from 37 international samples with 1115 SAD patients and 2775 controls were obtained from ENIGMA-standardized protocols for image segmentation and quality assurance. Linear mixed-effects analyses were adjusted for comparisons across seven subcortical regions in each hemisphere using family-wise error (FWE)-correction. Mixed-effects d effect sizes were calculated. In the full sample, SAD patients showed smaller bilateral putamen volume than controls (left: d = -0.077, pFWE = 0.037; right: d = -0.104, pFWE = 0.001), and a significant interaction between SAD and age was found for the left putamen (r = -0.034, pFWE = 0.045). Smaller bilateral putamen volumes (left: d = -0.141, pFWE < 0.001; right: d = -0.158, pFWE < 0.001) and larger bilateral pallidum volumes (left: d = 0.129, pFWE = 0.006; right: d = 0.099, pFWE = 0.046) were detected in adult SAD patients relative to controls, but no volumetric differences were apparent in adolescent SAD patients relative to controls. Comorbid anxiety disorders and age of SAD onset were additional determinants of SAD-related volumetric differences in subcortical regions. To conclude, subtle volumetric alterations in subcortical regions in SAD were detected. Heterogeneity in age and clinical characteristics may partly explain inconsistencies in previous findings. The association between alterations in subcortical volumes and SAD illness progression deserves further investigation, especially from adolescence into adulthood.

The Effectiveness of School-Based Skills-Training Programs Reducing Performance or Social Anxiety: Two Randomized Controlled Trials

Background

Given that high levels of stress during adolescence are associated with negative consequences, it is important that adolescents with psychological needs are supported at an early stage, for instance with interventions at school. However, knowledge about the potential of school-based programs targeting adolescents with psychological needs, aimed at reducing school or social stress, is lacking.

Objective

The current study aimed to investigate the effectiveness of two targeted school-based skills-training programs, addressing either skills to deal with performance anxiety or social skills.

Methods

Two randomized controlled trials were performed with participants who self-selected to one of the programs. The sample comprised of N = 361 adolescents (M age = 13.99 years, SD = 0.83) from various educational levels and ethnic identity backgrounds. The performance anxiety program included N = 196 participants (N = 95 in the experimental group), while the social skills program included N = 165 participants (N = 86 in the experimental group). MANCOVA's were performed.

Results

The performance anxiety program had a small effect on reducing adolescents' test anxiety. Furthermore, for adolescents who attended more than half of the sessions, the program had small effects on reducing test anxiety and fear of failure. The program did not improve adolescents' coping skills or mental health. The social skills program was not effective in improving social skills, social anxiety, and mental health.

Conclusions

A relatively short, targeted program addressing skills to deal with performance anxiety can have the potential to reduce adolescents' performance anxiety.

Trial registration

International Clinical Trials Registry Platform (Netherlands Trial Register, number NTR7680). Registered 12 December 2018. Study protocol van Loon et al., (2019).

Supplementary Information

The online version contains supplementary material available at 10.1007/s10566-023-09736-x.

Informative value of referral letters from general practice for child and adolescent mental healthcare

Although referral letters (RLs) form a nodal point in a patient's care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative value of RLs to child and adolescent psychiatry, we conducted a chart review in medical records of minors registered at specialized mental healthcare between January 2015 and December 2017 (The Netherlands). Symptoms indicated in RLs originating from general practice (N = 723) were coded and cross-tabulated with the best estimate clinical classifications made in psychiatry. Results revealed that over half of the minors in the sample were classified in concordance with at least one reason for referral. We found fair to excellent discriminative ability for indications made in RLs concerning the most common psychiatric classifications (95% CI AUC: 60.9-70.6 for anxiety disorders to 90.5-100.0 for eating disorders). Logistic regression analyses suggested no statistically significant effects of gender, age, severity or mental healthcare history, with the exception of age and attention deficit hyperactivity disorders (ADHD), as RLs better predicted ADHD with increasing age (OR = 1.14, 95% CI 1.03-1.27). Contextual problems, such as difficulties studying, problems with parents or being bullied were indicated frequently and associated with classifications in various disorder groups. To conclude, general practitioners' RLs showed informative value, contrary to common beliefs. Replication studies are needed to reliably incorporate RLs into the diagnostic work-up.

The diagnostic process from primary care to child and adolescent mental healthcare services: the incremental value of information conveyed through referral letters, screening questionnaires and structured multi-informant assessment

BACKGROUND

A variety of information sources are used in the best-evidence diagnostic procedure in child and adolescent mental healthcare, including evaluation by referrers and structured assessment questionnaires for parents. However, the incremental value of these information sources is still poorly examined.

AIMS

To quantify the added and unique predictive value of referral letters, screening, multi-informant assessment and clinicians' remote evaluations in predicting mental health disorders.

METHOD

Routine medical record data on 1259 referred children and adolescents were retrospectively extracted. Their referral letters, responses to the Strengths and Difficulties Questionnaire (SDQ), results on closed-ended questions from the Development and Well-Being Assessment (DAWBA) and its clinician-rated version were linked to classifications made after face-to-face intake in psychiatry. Following multiple imputations of missing data, logistic regression analyses were performed with the above four nodes of assessment as predictors and the five childhood disorders common in mental healthcare (anxiety, depression, autism spectrum disorders, attention-deficit hyperactivity disorder, behavioural disorders) as outcomes. Likelihood ratio tests and diagnostic odds ratios were computed.

RESULTS

Each assessment tool significantly predicted the classified outcome. Successive addition of the assessment instruments improved the prediction models, with the exception of behavioural disorder prediction by the clinician-rated DAWBA. With the exception of the SDQ for depressive and behavioural disorders, all instruments showed unique predictive value.

CONCLUSIONS

Structured acquisition and integrated use of diverse sources of information supports evidence-based diagnosis in clinical practice. The clinical value of structured assessment at the primary-secondary care interface should now be quantified in prospective studies.

The effects of school‐based interventions on physiological stress in adolescents: A meta‐analysis

Chronic stress is associated with dysregulations in the physiological stress system, resulting in diverse negative developmental outcomes. Since adolescence is a period characterized by increased stress-sensitivity, and schools are an important environment for the developing adolescent, school-based interventions promoting psychosocial functioning are of particular interest to prevent adverse outcomes. The present study therefore aimed to investigate the effectiveness of such interventions on hypothalamic pituitary adrenal-axis (i.e., cortisol) and cardiovascular (i.e., blood pressure [BP] and heart rate [HR]/heart rate variability [HRV]) parameters of stress in adolescents, and examined moderators of effectiveness. The search resulted in the inclusion of k = 9 studies for cortisol, k = 16 studies for BP, and k = 20 studies for HR/HRV. The results indicated a significant small overall effect on reducing BP, but no significant effect for HR/HRV. For cortisol, large methodological variation in the few primary studies did not allow for quantitative analyses, but a qualitative review demonstrated inconsistent results. For BP and HR/HRV, larger effects were observed for intervention programs with a mindfulness and/or meditation component, for interventions without a cognitive-behavioural component and for interventions with a higher intensity. Providing adolescents with techniques to improve indicators of physiological stress may prevent emerging mental health problems.

ENIGMA-anxiety working group: Rationale for and organization of large-scale neuroimaging studies of anxiety disorders

Anxiety disorders are highly prevalent and disabling but seem particularly tractable to investigation with translational neuroscience methodologies. Neuroimaging has informed our understanding of the neurobiology of anxiety disorders, but research has been limited by small sample sizes and low statistical power, as well as heterogenous imaging methodology. The ENIGMA-Anxiety Working Group has brought together researchers from around the world, in a harmonized and coordinated effort to address these challenges and generate more robust and reproducible findings. This paper elaborates on the concepts and methods informing the work of the working group to date, and describes the initial approach of the four subgroups studying generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobia. At present, the ENIGMA-Anxiety database contains information about more than 100 unique samples, from 16 countries and 59 institutes. Future directions include examining additional imaging modalities, integrating imaging and genetic data, and collaborating with other ENIGMA working groups. The ENIGMA consortium creates synergy at the intersection of global mental health and clinical neuroscience, and the ENIGMA-Anxiety Working Group extends the promise of this approach to neuroimaging research on anxiety disorders.

Concurrent and Prospective Associations Between Social Anxiety and Responses to Stress in Adolescence

Several studies have investigated the relationship between adolescents' responses to stress and general anxiety and depression, but only few studies addressed the relationship between responses to stress and social anxiety. The current three-wave longitudinal study, that covered a period of 5 years with a time interval of on average two years between waves, examined concurrent as well as prospective relations between adolescents' self-reported stress responses, including coping responses, and self-perceived social anxiety. Both the predictive power of social anxiety for different stress responses and, reversely, of stress responses for social anxiety were evaluated. Participants were 331 youth (170 boys) aged 9 to 17 years old at Wave 1. Self-report questionnaires were used to measure social anxiety, responses to social stress, and depressive symptoms. Results showed significant concurrent relations between social anxiety and maladaptive stress responses. Moreover, the study yielded evidence for social anxiety predicting stress responses across time as well as stress responses predicting social anxiety, although evidence for the former link is stronger. The findings suggest that a relative lack of adaptive stress responses may heighten social anxiety and social anxiety in turn may trigger maladaptive as well as adaptive responses to social problems. The relevance of these findings for social anxiety prevention and intervention purposes are discussed.

Prepandemic Risk Factors of COVID-19-Related Concerns in Adolescents During the COVID-19 Pandemic

To identify adolescents who may be at risk for adverse outcomes, we examined the extent of COVID-19-related concerns reported by adolescents and investigated which prepandemic risk and protective factors predicted these concerns during the COVID-19 pandemic. Dutch adolescents (N = 188; M_age  = 13.49, SD = .81) were assessed before the pandemic and at eight and ten months into the pandemic. Results demonstrated that adolescents' most frequently reported COVID-19-related concerns were about social activities and getting delayed in school. Adolescents that have specific vulnerabilities before the pandemic (i.e., higher stress, maladaptive coping, or internalizing problems) experience more concerns during the pandemic, stressing the importance of guiding and supporting these adolescents in order to prevent adverse developmental outcomes.

Intrinsic functional connectivity in families genetically enriched for social anxiety disorder - an endophenotype study

BACKGROUND

Social anxiety disorder (SAD) is a serious psychiatric condition with a high prevalence, and a typical onset during childhood/adolescence. The condition runs in families, but it is largely unknown which neurobiological characteristics transfer this genetic vulnerability ('endophenotypes'). Using data from the Leiden Family Lab study on SAD, including two generations of families genetically enriched for SAD, we investigated whether social anxiety (SA) co-segregated with changes in intrinsic functional connectivity (iFC), and examined heritability.

METHODS

Functional MRI data were acquired during resting-state in 109 individuals (56 males; mean age: 31·5, range 9·2-61·5 years). FSL's tool MELODIC was used to perform independent component analysis. Six networks of interest (default mode, dorsal attention, executive control, frontoparietal, limbic and salience) were identified at the group-level and used to generate subject-specific spatial maps. Voxel-wise regression models, with SA-level as predictor and voxel-wise iFC as candidate endophenotypes, were performed to investigate the association with SA, within masks of the networks of interest. Subsequently, heritability was estimated.

FINDINGS

SA co-segregated with iFC within the dorsal attention network (positive association in left middle frontal gyrus and right postcentral gyrus) and frontoparietal network (positive association within left middle temporal gyrus) (cluster-forming-threshold z>2·3, cluster-corrected extent-threshold p<0·05). Furthermore, iFC of multiple voxels within these clusters was at least moderately heritable.

INTERPRETATION

These findings provide initial evidence for increased iFC as candidate endophenotype of SAD, particularly within networks involved in attention. These changes might underlie attentional biases commonly present in SAD.

FUNDING

Leiden University Research Profile 'Health, Prevention and the Human Lifecycle'.

Investigating microstructure of white matter tracts as candidate endophenotypes of Social Anxiety Disorder - Findings from the Leiden Family Lab study on Social Anxiety Disorder (LFLSAD)

BACKGROUND

Social anxiety disorder (SAD) is a mental illness with a complex, partially genetic background. Differences in characteristics of white matter (WM) microstructure have been reported in patients with SAD compared to healthy controls. Also, WM characteristics are moderately to highly heritable. Endophenotypes are measurable characteristics on the road from genotype to phenotype, putatively reflective of genetically based disease mechanisms. In search of candidate endophenotypes of SAD we used a unique sample of SAD patients and their family members of two generations to explore microstructure of WM tracts as candidate endophenotypes. We focused on two endophenotype criteria: co-segregation with social anxiety within the families, and heritability.

METHODS

Participants (n = 94 from 8 families genetically vulnerable for SAD) took part in the Leiden Family Lab Study on Social Anxiety Disorder (LFLSAD). We employed tract-based spatial statistics to examine structural WM characteristics, being fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD) and radial diffusivity (RD), in three a-priori defined tracts of interest: uncinate fasciculus (UF), superior longitudinal fasciculus (SLF) and inferior longitudinal fasciculus (ILF). Associations with social anxiety symptoms and heritability were estimated.

RESULTS

Increased FA in the left and right SLF co-segregated with symptoms of social anxiety. These findings were coupled with decreased RD and MD. All characteristics of WM microstructure were estimated to be at least moderately heritable.

CONCLUSION

These findings suggest that alterations in WM microstructure in the SLF could be candidate endophenotypes of SAD, as they co-segregated within families genetically vulnerable for SAD and are heritable. These findings further elucidate the genetic susceptibility to SAD and improve our understanding of the overall etiology.

Recognition of anxiety disorders in children: a cross-sectional vignette-based survey among general practitioners

OBJECTIVE

To quantify general practitioners' (GPs) sensitivity to anxiety disorders (ADs) when confronted with the range of symptoms common to children with ADs. Also, to explore GPs' conscious preferences and implicit tendencies for referral of children with ADs to mental healthcare.

DESIGN AND SETTING

In a cross-sectional vignette-based survey, all attendees of a Dutch continuing medical education conference for primary care physicians were presented with subtitled audio fragments of five vignettes that we constructed to mimic symptom presentation of children with ADs in general practice. We asked attendees to select per vignette the most plausible diagnoses and most adequate referral option, and for their general referral preferences when they suspect each of the most common mental health problems.

PARTICIPANTS

A sample of 229 GPs, resulting in a total of 1128 vignette evaluations.

MAIN OUTCOME MEASURE

GPs' selection rate of ADs in the five vignettes compared with a benchmark provided by mental health professionals (MHPs).

RESULTS

Overall, recognition of ADs was less likely in GPs compared with MHPs (OR=0.26, 95% CI 0.15 to 0.46). GPs varied in their recognition of anxiety, with 44.1% not once selecting anxiety as the probable presenting problem. When asked explicitly, 63.9% of the GPs reported that they would refer a child to mental healthcare when they suspect probable ADs. By contrast, only 12.0% of the GPs who recognised anxiety in the vignettes actually selected that referral option.

CONCLUSION

A significant fraction of GPs did not notice the depicted symptoms as anxiety. Despite the widespread prevalence of ADs, GPs seem to overlook anxiety already in their early diagnostic opinion. Improving GPs' familiarity with initial symptom presentation, ADs' base-rate, relevance and impact yields potential for timely recognition.

Imaging the socially-anxious brain: recent advances and future prospects

Social anxiety disorder (SAD) is serious psychiatric condition with a genetic background. Insight into the neurobiological alterations underlying the disorder is essential to develop effective interventions that could relieve SAD-related suffering. In this expert review, we consider recent neuroimaging work on SAD. First, we focus on new results from magnetic resonance imaging studies dedicated to outlining biomarkers of SAD, including encouraging findings with respect to structural and functional brain alterations associated with the disorder. Furthermore, we highlight innovative studies in the field of neuroprediction and studies that established the effects of treatment on brain characteristics. Next, we describe novel work aimed to delineate endophenotypes of SAD, providing insight into the genetic susceptibility to develop the disorder. Finally, we outline outstanding questions and point out directions for future research.

Amygdala hyperreactivity to faces conditioned with a social-evaluative meaning- a multiplex, multigenerational fMRI study on social anxiety endophenotypes

Social anxiety disorder (SAD) runs in families, but the neurobiological pathways underlying the genetic susceptibility towards SAD are largely unknown. Here, we employed an endophenotype approach, and tested the hypothesis that amygdala hyperreactivity to faces conditioned with a social-evaluative meaning is a candidate SAD endophenotype. We used data from the multiplex, multigenerational Leiden Family Lab study on Social Anxiety Disorder (eight families, n = 105) and investigated amygdala activation during a social-evaluative conditioning paradigm with high ecological validity in the context of SAD. Three neutral faces were repeatedly presented in combination with socially negative, positive or neutral sentences. We focused on two endophenotype criteria: co-segregation of the candidate endophenotype with the disorder within families, and heritability. Analyses of the fMRI data were restricted to the amygdala as a region of interest, and association analyses revealed that bilateral amygdala hyperreactivity in response to the conditioned faces co-segregated with social anxiety (SA; continuous measure) within the families; we found, however, no relationship between SA and brain activation in response to more specific fMRI contrasts. Furthermore, brain activation in a small subset of voxels within these amygdala clusters was at least moderately heritable. Taken together, these findings show that amygdala engagement in response to conditioned faces with a social-evaluative meaning qualifies as a neurobiological candidate endophenotype of social anxiety. Thereby, these data shed light on the genetic vulnerability to develop SAD.

A systematic review of visual avoidance of faces in socially anxious individuals: Influence of severity, type of social situation, and development

Although visual avoidance of faces is a hallmark feature of social anxiety disorder (SAD) on clinical and theoretical grounds, empirical support is equivocal. This review aims to clarify under which conditions socially anxious individuals display visual avoidance of faces. Through a systematic search in Web of Science and PubMed up to March 2019 we identified 61 publications that met the inclusion criteria. We discuss the influence of three factors on the extent to which socially anxious individuals avoid looking at faces: (a) severity of social anxiety symptoms (diagnosed SAD versus High Social Anxiety levels in community samples [HSA] or related characteristics [Shyness, Fear of Negative Evaluation]), (b) three types of social situation (computer facial-viewing tasks, speaking tasks, social interactions), and (c) development (age-group). Adults with SAD exhibit visual avoidance across all three types of social situations, whereas adults with HSA exhibit visual avoidance in speaking and interaction tasks but not in facial-viewing tasks. The relatively few studies with children and adolescents suggest that visual avoidance emerges during adolescence. The findings are discussed in the context of cognitive-behavioral and skills-deficit models. Suggestions for future research include the need for developmental studies and more fine-grained analyses of specific areas of the face.

Can Schools Reduce Adolescent Psychological Stress? A Multilevel Meta-Analysis of the Effectiveness of School-Based Intervention Programs

Increased levels of psychological stress during adolescence have been associated with a decline in academic performance, school dropout and increased risk of mental health problems. Intervening during this developmental period may prevent these problems. The school environment seems particularly suitable for interventions and over the past decade, various school-based stress reduction programs have been developed. The present study aims to evaluate the results of (quasi-)experimental studies on the effectiveness of school-based intervention programs targeting adolescent psychological stress and to investigate moderators of effectiveness. A three-level random effects meta-analytic model was conducted. The search resulted in the inclusion of k = 54 studies, reporting on analyses in 61 independent samples, yielding 123 effect sizes (N = 16,475 individuals). The results indicated a moderate overall effect on psychological stress. Yet, significant effects were only found in selected student samples. School-based intervention programs targeting selected adolescents have the potential to reduce psychological stress. Recommendations for practice, policy and future research are discussed.

Impaired neural habituation to neutral faces in families genetically enriched for social anxiety disorder

BACKGROUND

Social anxiety disorder (SAD) is an incapacitating disorder running in families. Previous work associated social fearfulness with a failure to habituate, but the habituation response to neutral faces has, as of yet, not been investigated in patients with SAD and their family members concurrently. Here, we examined whether impaired habituation to neutral faces is a putative neurobiological endophenotype of SAD by using data from the multiplex and multigenerational Leiden Family Lab study on SAD.

METHODS

Participants (n = 110; age, 9.2 - 61.5 years) performed a habituation paradigm involving neutral faces, as these are strong social stimuli with an ambiguous meaning. We used functional magnetic resonance imaging data to investigate whether brain activation related to habituation was associated with the level of social anxiety within the families. Furthermore, the heritability of the neural habituation response was estimated.

RESULTS

Our data revealed a relationship between impaired habituation to neutral faces and social anxiety in the right hippocampus and right amygdala. In addition, our data indicated that this habituation response displayed moderate - to-moderately high heritability in the right hippocampus.

CONCLUSION

The present results provide support for altered habituation as a candidate SAD endophenotype; impaired neural habitation cosegregrated with the disorder within families and was heritable. These findings shed light on the genetic susceptibility to SAD.

A cross-sectional and longitudinal network analysis approach to understanding connections among social anxiety components in youth

As proposed in a prominent developmental model, social anxiety has different manifestations: social fear, shy temperament, anxious cognitions, and avoidance of social situations. Drawing from this model, we used the network approach to psychopathology to gain a detailed understanding of specific social anxiety components and their associations. The current article investigated (a) how social anxiety components are interconnected within a network, and (b) the consistency of the network over time, in a community sample of children and adolescents. Data from 3 waves of a longitudinal study were used. At Time 1 (T1) the total sample comprised 331 participants (M_age = 13.34 years); at Time 3 (T3) there were 236 participants (M_age = 17.48 years). Social anxiety components were assessed with self-report questionnaires. Networks of 15 nodes (i.e., components) were estimated. Network analysis of T1 components revealed 4 communities: cognitive, social-emotional, avoidance of performance, and avoidance of interaction situations. There were no direct connections between the cognitive and behavioral communities; social-emotional nodes appeared to act as bridge components between the 2 communities. A similar pattern of component associations and communities was found in the T2 and T3 networks, and the longitudinal network incorporating node change trajectories. Networks were estimated on group-level observational data and conclusions about cause-effect relationships are tentative. Although the sample size decreased across the 3 waves, the reliability of parameter estimates were minimally affected. Findings attest to the potential value of applying the network approach to investigate the pattern of associations among social anxiety components in youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The effectiveness of school-based skills-training programs promoting mental health in adolescents: a study protocol for a randomized controlled study

Background

Adolescence is a period of elevated stress sensitivity, which places adolescents at increased risk of developing mental health problems such as burnout, depression, anxiety, and externalizing problems. Early intervention of psychological needs and low-threshold care addressing such needs may prevent this dysfunctional development. Schools may provide an important environment to identify and address psychological needs. The aim of this protocol is to describe the design of a study aiming to evaluate the effectiveness of low-threshold school-based skills-training programs promoting the mental health of adolescents and to examine moderators of the effectiveness.

Methods

A Randomized Controlled Trial will be conducted to examine the effectiveness of two school-based skills-training programs aiming to promote mental health by improving either skills to deal with performance anxiety or social skills. A multi-informant (i.e., students, parents, and trainers) and multi-method (i.e., questionnaires and physiological measurements) approach will be used to assess program targets (skills to deal with performance anxiety or social skills), direct program outcomes (performance or social anxiety) and mental health outcomes (i.e., stress, internalizing and externalizing problems, self-esteem and well-being), as well as specific moderators (i.e., student, parent and program characteristics, social support, perfectionism, stressful life events, perceived parental pressure, positive parenting behavior, treatment alliance and program integrity).

Discussion

The current study will provide information on the effectiveness of school-based skills-training programs. It is of crucial importance that the school environment can provide students with effective, low-threshold intervention programs to promote adolescents’ daily functioning and well-being and prevent the emergence of mental health problems that negatively affect school performance.

Trial registration

Dutch Trial Register number NL7438. Registered 12 December 2018.

Cultural evidence for interpretation bias as a feature of social anxiety in Chinese adolescents

Background and Objectives: Interpretation bias (IB), defined as the tendency to interpret ambiguous social situations in a threatening manner, has increasingly been studied in children and adolescents. Compared to Western samples, the relation between IB and social anxiety in Chinese youth has received little attention. The present study was to mainly examine the relationship between IB and social anxiety among Chinese adolescents. Design: Cross-sectional design was utilized. Methods: IB, measured by the Adolescents' Interpretation Bias Questionnaire (AIBQ), and social anxiety were surveyed among a group of high socially anxious Chinese adolescents (n = 25) and a control group (n = 29). Participants were asked to rate the likelihood of interpretations coming to mind in social/non-social situations and to choose the most believable interpretation. Results: The high social anxiety group had more negative interpretations and beliefs in social situations, and the interpretation bias was particular to social anxiety versus depression. Additionally, the cognitive content-specificity hypothesis was supported; the high anxious group showed interpretation bias in social situations, but didn't have more negative interpretations of non-social situations, after controlling for depression. Conclusions: The present study yielded comparable findings as found in Western samples regarding the relation between IB and social anxiety.

Altered Neurobiological Processing of Unintentional Social Norm Violations: A Multiplex, Multigenerational Functional Magnetic Resonance Imaging Study on Social Anxiety Endophenotypes

BACKGROUND

Patients with social anxiety disorder (SAD) fear negative evaluation in social situations. Specifically, previous work indicated that social anxiety is associated with increased medial prefrontal cortex activation in response to unintentional social norm (SN) transgressions, accompanied by increased embarrassment ratings for such SN violations. Here, we used data from the multiplex, multigenerational LFLSAD (Leiden Family Lab study on Social Anxiety Disorder), which involved two generations of families genetically enriched for SAD, and investigated whether these neurobiological and behavioral correlates of unintentional SN processing are SAD endophenotypes. Of four endophenotype criteria, we examined two: first, the cosegregation of these characteristics with social anxiety (SA) within families of SAD probands (criterion 4), and second, the heritability of the candidate endophenotypes (criterion 3).

METHODS

Participants (n = 110, age range 9.0-61.5 years, eight families) performed the revised Social Norm Processing Task; functional magnetic resonance imaging data and behavioral ratings related to this paradigm were used to examine whether brain activation in response to processing unintentional SN violations and ratings of embarrassment were associated with SA levels. Next, heritability of these measurements was estimated.

RESULTS

As expected, voxelwise functional magnetic resonance imaging analyses revealed positive associations between SA levels and brain activation in the medial prefrontal cortex and medial temporal gyrus, superior temporal gyrus, and superior temporal sulcus, and these brain activation levels displayed moderate to moderately high heritability. Furthermore, although SA levels correlated positively with behavioral ratings of embarrassment for SN transgressions, these behavioral characteristics were not heritable.

CONCLUSIONS

These results show, for the first time, that brain responses in the medial prefrontal cortex and medial temporal gyrus, superior temporal gyrus, and superior temporal sulcus, related to processing unintentional SN violations, provide a neurobiological candidate endophenotype of SAD.

The temporal association between emotional clarity and depression symptoms in adolescents

INTRODUCTION

Low emotional clarity, that is, problems in understanding and identifying one's own emotions, is generally seen as related to depression. Most empirical studies on this topic focused on the link between low levels of emotional clarity predicting depression problems, fewer studies on depression symptoms predicting low emotional clarity. All studies were restricted to unidirectional associations. The present study evaluated the reciprocal associations between emotional clarity and depression symptoms. Additionally, we tested the role of rumination as a mediator of the links between depression symptoms and emotional clarity.

METHODS

For the main analyses, data of 230 Dutch participants (M_age = 13.40, SD = 2.24; 48% girls) over three time points of a 5-year longitudinal study were used. Depression symptoms, emotional clarity, and rumination were self-reported. Cross-lagged panel analysis was used to test a model of reciprocal associations between depression symptoms and emotional clarity against models of unidirectional associations. The role of rumination as mediator and sex as moderator in the links between depression symptoms and emotional clarity were evaluated in separate analyses on a subsample (n = 151).

RESULTS & CONCLUSIONS

A model of reciprocal associations where depression symptoms and low emotional clarity predict relatively high scores of the other over time offered a good representation of the data. Rumination mediated the link between depression symptoms predicting prospective emotional clarity for both sexes. These findings suggest a vicious cycle between depression symptoms and low emotional clarity. We discuss possible implications of these results for the treatment of depression in youth.

Subcortical brain volumes, cortical thickness and cortical surface area in families genetically enriched for social anxiety disorder - A multiplex multigenerational neuroimaging study

BACKGROUND

Social anxiety disorder (SAD) is a disabling psychiatric condition with a genetic background. Brain alterations in gray matter (GM) related to SAD have been previously reported, but it remains to be elucidated whether GM measures are candidate endophenotypes of SAD. Endophenotypes are measurable characteristics on the causal pathway from genotype to phenotype, providing insight in genetically-based disease mechanisms. Based on a review of existing evidence, we examined whether GM characteristics meet two endophenotype criteria, using data from a unique sample of SAD-patients and their family-members of two generations. First, we investigated whether GM characteristics co-segregate with social anxiety within families genetically enriched for SAD. Secondly, heritability of the GM characteristics was estimated.

METHODS

Families with a genetic predisposition for SAD participated in the Leiden Family Lab study on SAD; T1-weighted MRI brain scans were acquired (n = 110, 8 families). Subcortical volumes, cortical thickness and cortical surface area were determined for a-priori determined regions of interest (ROIs). Next, associations with social anxiety and heritabilities were estimated.

FINDINGS

Several subcortical and cortical GM characteristics, derived from frontal, parietal and temporal ROIs, co-segregated with social anxiety within families (uncorrected p-level) and showed moderate to high heritability.

INTERPRETATION

These findings provide preliminary evidence that GM characteristics of multiple ROIs, which are distributed over the brain, are candidate endophenotypes of SAD. Thereby, they shed light on the genetic vulnerability for SAD. Future research is needed to confirm these results and to link them to functional brain alterations and to genetic variations underlying these GM changes. FUND: Leiden University Research Profile 'Health, Prevention and the Human Life Cycle'.

Heart rate variability as candidate endophenotype of social anxiety: A two-generation family study

BACKGROUND

Social anxiety disorder (SAD) is the extreme fear and avoidance of one or more social situations. The goal of the current study was to investigate whether heart rate variability (HRV) during resting state and a social performance task (SPT) is a candidate endophenotype of SAD.

METHODS

In this two-generation family study, patients with SAD with their partner and children, and their siblings with partner and children took part in a SPT (total n = 121, 9 families, 3-30 persons per family, age range: 8-61 years, 17 patients with SAD). In this task, participants had to watch and evaluate the speech of a female peer, and had to give a similar speech. HRV was measured during two resting state phases, and during anticipation, speech and recovery phases of the SPT. We tested two criteria for endophenotypes: co-segregation with SAD within families and heritability.

RESULTS

HRV did not co-segregate with SAD within families. Root mean square of successive differences during the first resting phase and recovery, and high frequency power during all phases of the task were heritable.

LIMITATIONS

It should be noted that few participants were diagnosed with SAD. Results during the speech should be interpreted with caution, because the duration was short and there was a lot of movement.

CONCLUSIONS

HRV during resting state and the SPT is a possible endophenotype, but not of SAD. As other studies have shown that HRV is related to different internalizing disorders, HRV might reflect a transdiagnostic genetic vulnerability for internalizing disorders. Future research should investigate which factors influence the development of psychopathology in persons with decreased HRV.

The Leiden Family Lab study on Social Anxiety Disorder: A multiplex, multigenerational family study on neurocognitive endophenotypes

OBJECTIVES

Social anxiety disorder (SAD) is a serious and prevalent psychiatric condition, with a heritable component. However, little is known about the characteristics that are associated with the genetic component of SAD, the so-called "endophenotypes". These endophenotypes could advance our insight in the genetic susceptibility to SAD, as they are on the pathway from genotype to phenotype. The Leiden Family Lab study on Social Anxiety Disorder (LFLSAD) is the first multiplex, multigenerational study aimed to identify neurocognitive endophenotypes of social anxiety.

METHODS

The LFLSAD is characterized by a multidisciplinary approach and encompasses a variety of measurements, including a clinical interview, functional and structural magnetic resonance imaging and an electroencephalography experiment. Participants are family members from 2 generations, from families genetically enriched for SAD.

RESULTS

The sample (n = 132 participants, from 9 families) was characterized by a high prevalence of SAD, in both generations (prevalence (sub)clinical SAD: 38.3%). Furthermore, (sub)clinical SAD was positively related to self-reported social anxiety, fear of negative evaluation, trait anxiety, behavioral inhibition, negative affect, and the level of depressive symptoms.

CONCLUSIONS

By the multidimensional character of the measurements and thorough characterization of the sample, the LFLSAD offers unique opportunities to investigate candidate neurocognitive endophenotypes of SAD.

Will they like me? Neural and behavioral responses to social-evaluative peer feedback in socially and non-socially anxious females

The current study examined neural and behavioral responses to social-evaluative feedback processing in social anxiety. Twenty-two non-socially and 17 socially anxious females (mean age = 19.57 years) participated in a Social Judgment Paradigm in which they received peer acceptance/rejection feedback that was either congruent or incongruent with their prior predictions. Results indicated that socially anxious participants believed they would receive less social acceptance feedback than non-socially anxious participants. EEG results demonstrated that unexpected social rejection feedback elicited a significant increase in theta (4-8 Hz) power relative to other feedback conditions. This theta response was only observed in non-socially anxious individuals. Together, results corroborate cognitive-behavioral studies demonstrating a negative expectancy bias in socially anxiety with respect to social evaluation. Furthermore, the present findings highlight a functional role for theta oscillatory dynamics in processing cues that convey social-evaluative threat, and this social threat-monitoring mechanism seems less sensitive in socially anxious females.

Delta-beta correlation as a candidate endophenotype of social anxiety: A two-generation family study

BACKGROUND

Social anxiety disorder (SAD) is characterized by an extreme and intense fear and avoidance of social situations. In this two-generation family study we examined delta-beta correlation during a social performance task as candidate endophenotype of SAD.

METHODS

Nine families with a target participant (diagnosed with SAD), their spouse and children, as well as target's siblings with spouse and children performed a social performance task in which they gave a speech in front of a camera. EEG was measured during resting state, anticipation, and recovery. Our analyses focused on two criteria for endophenotypes: co-segregation within families and heritability.

RESULTS

Co-segregation analyses revealed increased negative delta-low beta correlation during anticipation in participants with (sub)clinical SAD compared to participants without (sub)clinical SAD. Heritability analyses revealed that delta-low beta and delta-high beta correlation during anticipation were heritable. Delta-beta correlation did not differ between participants with and without (sub)clinical SAD during resting state or recovery, nor between participants with and without SAD during all phases of the task.

LIMITATIONS

It should be noted that participants were seen only once, they all performed the EEG tasks in the same order, and some participants were too anxious to give a speech.

CONCLUSIONS

Delta-low beta correlation during anticipation of giving a speech might be a candidate endophenotype of SAD, possibly reflecting increased crosstalk between cortical and subcortical regions. If validated as endophenotype, delta-beta correlation during anticipation could be useful in studying the genetic basis, as well as improving treatment and early detection of persons at risk for developing SAD.

Behavioral and EEG responses to social evaluation: A two-generation family study on social anxiety

Social anxiety disorder is an invalidating psychiatric disorder characterized by extreme fear and avoidance of one or more social situations in which patients might experience scrutiny by others. The goal of this two-generation family study was to delineate behavioral and electrocortical endophenotypes of social anxiety disorder related to social evaluation. Nine families of patients with social anxiety disorder (their spouse and children, and siblings of these patients with spouse and children) performed a social judgment paradigm in which they believed to be evaluated by peers. For each peer, participants indicated their expectation about the evaluative outcome, after which they received social acceptance or rejection feedback. Task behavior, as well as the feedback-related EEG brain potentials (N1, FRN, P3) and theta power were tested as candidate endophenotypes based on two criteria: co-segregation with social anxiety disorder within families and heritability. Results indicated that reaction time for indicating acceptance-expectations might be a candidate behavioral endophenotype of social anxiety disorder, possibly reflecting increased uncertainty or self-focused attention and vigilance during the social judgment paradigm. N1 in response to expected rejection feedback and P3 in response to acceptance feedback might be candidate electrocortical endophenotypes of social anxiety disorder, although the heritability analyses did not remain significant after correcting for multiple tests. Increased N1 possibly reflects hypervigilance to socially threatening stimuli, and increased P3 might reflect that positive feedback is more important for, and/or less expected by, participants with social anxiety disorder. Finally, increased feedback-related negativity and theta power in response to unexpected rejection feedback compared to the other conditions co-segregated with social anxiety disorder, but these EEG measures were not heritable. The candidate endophenotypes might play a new and promising role in future research on genetic mechanisms, early detection and/or prevention of social anxiety disorder.

How embarrassing! The behavioral and neural correlates of processing social norm violations

Social norms are important for human social interactions, and violations of these norms are evaluated partly on the intention of the actor. Here, we describe the revised Social Norm Processing Task (SNPT-R), a paradigm enabling the study of behavioral and neural responses to intended and unintended social norm violations among both adults and adolescents. We investigated how participants (adolescents and adults, n = 87) rate intentional and unintentional social norm violations with respect to inappropriateness and embarrassment, and we examined the brain activation patterns underlying the processing of these transgressions in an independent sample of 21 adults using functional Magnetic Resonance Imaging (fMRI). We hypothesized to find activation within the medial prefrontal cortex, temporo-parietal cortex and orbitofrontal cortex in response to both intentional and unintentional social norm violations, with more pronounced activation for the intentional social norm violations in these regions and in the amygdala. Participants' ratings confirmed the hypothesis that the three types of stories are evaluated differently with respect to intentionality: intentional social norm violations were rated as the most inappropriate and most embarrassing. Furthermore, fMRI results showed that reading stories on intentional and unintentional social norm violations evoked activation within the frontal pole, the paracingulate gyrus and the superior frontal gyrus. In addition, processing unintentional social norm violations was associated with activation in, among others, the orbitofrontal cortex, middle frontal gyrus and superior parietal lobule, while reading intentional social norm violations was related to activation in the left amygdala. These regions have been previously implicated in thinking about one's self, thinking about others and moral reasoning. Together, these findings indicate that the SNPT-R could serve as a useful paradigm for examining social norm processing, both at the behavioral and the neural level.

Why don't you like me? Midfrontal theta power in response to unexpected peer rejection feedback

Social connectedness theory posits that the brain processes social rejection as a threat to survival. Recent electrophysiological evidence suggests that midfrontal theta (4-8Hz) oscillations in the EEG provide a window on the processing of social rejection. Here we examined midfrontal theta dynamics (power and inter-trial phase synchrony) during the processing of social evaluative feedback. We employed the Social Judgment paradigm in which 56 undergraduate women (mean age=19.67 years) were asked to communicate their expectancies about being liked vs. disliked by unknown peers. Expectancies were followed by feedback indicating social acceptance vs. rejection. Results revealed a significant increase in EEG theta power to unexpected social rejection feedback. This EEG theta response could be source-localized to brain regions typically reported during activation of the saliency network (i.e., dorsal anterior cingulate cortex, insula, inferior frontal gyrus, frontal pole, and the supplementary motor area). Theta phase dynamics mimicked the behavior of the time-domain averaged feedback-related negativity (FRN) by showing stronger phase synchrony for feedback that was unexpected vs. expected. Theta phase, however, differed from the FRN by also displaying stronger phase synchrony in response to rejection vs. acceptance feedback. Together, this study highlights distinct roles for midfrontal theta power and phase synchrony in response to social evaluative feedback. Our findings contribute to the literature by showing that midfrontal theta oscillatory power is sensitive to social rejection but only when peer rejection is unexpected, and this theta response is governed by a widely distributed neural network implicated in saliency detection and conflict monitoring.

Effects of adolescent sociocognitive development on the cortisol response to social evaluation

Adolescents become increasingly sensitive to social evaluation. Some previous studies have related this change to pubertal development. The present longitudinal study examined the role of sociocognitive development. We investigated whether or not the transition to recursive thinking, the ability to think about (others') thoughts, would be associated with changes in the magnitude and timing of the cortisol response to social evaluation. Salivary cortisol was obtained during the Leiden Public Speaking Task. The task was administered twice with a 2-year interval to 221 participants, aged 9-17 years at Time 1. The area under the curve was computed to assess the magnitude of the overall cortisol response. Two difference scores, reflecting speech anticipation and speech delivery, were computed to assess the timing of the cortisol response. Recursive thinking was measured with a cartoon description task. Regression analyses with clustered bootstrap controlling for pubertal development, age, and general cognitive functioning showed that the transition to recursive thinking predicted an increase in the cortisol response to speech anticipation, but was unrelated to the magnitude of the overall cortisol response. This is in line with the view that increasing sensitivity to social evaluation in adolescence is mainly due to the effects of pubertal hormones on affective regions of the brain. Sociocognitive development affected the timing rather than the magnitude of the cortisol response. The results suggest that recursive thinking enables earlier realization of social-evaluative threat. (PsycINFO Database Record

Two-year stability of individual differences in (para)sympathetic and HPA-axis responses to public speaking in childhood and adolescence

Long-term stability of individual differences in stress responses has repeatedly been demonstrated in adults, but few studies have investigated the development of stability in adolescence. The present study was the first to investigate the stability of individual differences in heart rate, parasympathetic (RMSSD, pNN50, HF), sympathetic (LF/HF, SC), and HPA-axis (salivary cortisol) responses in a youth sample (8-19 years). Responses to public speaking were measured twice over 2 years. Stability was moderate for absolute responses and task delta responses of HR, RMSSD, pNN50, and HF. Stability was lower for SC and task delta responses of LF/HF and cortisol. Anticipation delta responses showed low stability for HR and cortisol. The latter was moderated by age or puberty, so that individual differences were more stable in more mature individuals. The results support the suggestion that stress responses may be reset during adolescence, but only for the HPA axis.

Fear of negative evaluation modulates electrocortical and behavioral responses when anticipating social evaluative feedback

Cognitive models posit that the fear of negative evaluation (FNE) is a hallmark feature of social anxiety. As such, individuals with high FNE may show biased information processing when faced with social evaluation. The aim of the current study was to examine the neural underpinnings of anticipating and processing social-evaluative feedback, and its correlates with FNE. We used a social judgment paradigm in which female participants (N = 31) were asked to indicate whether they believed to be socially accepted or rejected by their peers. Anticipatory attention was indexed by the stimulus preceding negativity (SPN), while the feedback-related negativity and P3 were used to index the processing of social-evaluative feedback. Results provided evidence of an optimism bias in social peer evaluation, as participants more often predicted to be socially accepted than rejected. Participants with high levels of FNE needed more time to provide their judgments about the social-evaluative outcome. While anticipating social-evaluative feedback, SPN amplitudes were larger for anticipated social acceptance than for social rejection feedback. Interestingly, the SPN during anticipated social acceptance was larger in participants with high levels of FNE. None of the feedback-related brain potentials correlated with the FNE. Together, the results provided evidence of biased information processing in individuals with high levels of FNE when anticipating (rather than processing) social-evaluative feedback. The delayed response times in high FNE individuals were interpreted to reflect augmented vigilance imposed by the upcoming social-evaluative threat. Possibly, the SPN constitutes a neural marker of this vigilance in females with higher FNE levels, particularly when anticipating social acceptance feedback.

Adolescents' increasing stress response to social evaluation: pubertal effects on cortisol and alpha-amylase during public speaking

Stress responses to social evaluation are thought to increase during adolescence, which may be due to pubertal maturation. However, empirical evidence is scarce. This study is the first to investigate the relation between pubertal development and biological responses to a social-evaluative stressor longitudinally. Participants performed the Leiden Public Speaking Task twice, with a 2-year interval (N = 217; age at Time 1: 8-17 years). The results support an increase in sensitivity to social evaluation during adolescence. The overall cortisol and alpha-amylase responses increased-both between and within participants-and were more strongly related to self-reported pubertal development than to age. The cortisol response shifted from speech delivery toward anticipation. The alpha-amylase response increased in both phases.

Trajectories of social anxiety during adolescence and relations with cognition, social competence, and temperament

This cohort-sequential study examined developmental trajectories of social anxiety in a nonclinical sample (N = 331, 161 girls) aged 9 to 17 years at initial and 12 to 21 years at final assessment. We tested whether variables assessing cognition, social competence, and temperament discriminated between the trajectories. Variables were collected from different sources: participants, independent observers, parents, and teachers. Using Latent Class Growth Modeling (LCGM) we identified three distinct social anxiety trajectory groups: i) high and changing; ii) moderate and decreasing; and iii) low and decreasing. Multinomial regression analyses showed that the cognition variables, negative interpretations of ambiguous social situations and self-focused attention, differentiated between all three trajectories. A lack of social skills and having social problems at school were specifically related to the chance of following the high trajectory versus the moderate trajectory. Neuroticism differentiated between the low and moderate trajectories. Findings indicate that adolescents at risk of belonging to a high social anxiety trajectory can be discriminated from peers belonging to a less anxious trajectory using both cognition and social competence variables.

Self-concept and ego development in deaf adolescents: a comparative study

Self-concept and ego development, two intertwined aspects of self-indicating well-being and social-cognitive maturation, respectively, were examined in a representative sample of deaf adolescents of normal intelligence (N = 68), using translated and adapted versions of Harter's (1988, Manual for the self-perception profile for adolescents. Denver, CO: University of Denver) multidimensional measure of self-concept and Loevinger's (1998, Technical foundations for measuring ego development. Mahwah, NJ: Lawrence Erlbaum) measure of ego development. Compared to hearing norm groups, deaf adolescents showed lower levels of self-perceived social acceptance, close friendships and ego development and higher physical appearance. Hierarchical multiple regression analyses controlling for sociodemographic variables showed positive associations of global self-worth with support for signing during childhood and quality of parent-child communication and of ego development with attending a regular school. Cluster analysis identified three social competence profiles: uniformly low competence, uniformly high competence, and low social acceptance with high physical appearance. Cluster membership was associated with school type, ego development, and (past) neurological disorder. The results are discussed in reference to interventions aimed at the well-being of deaf youth.

Negative Social Cognitions in Socially Anxious Youth: Distorted Reality or a Kernel of Truth?

We review studies that investigate negative social cognitions of socially anxious youth in relation to two specific domains: interpretation of ambiguous social situations and self-evaluation of social performance, including social skills and nervous behaviors. In this review, we address the question whether socially anxious youth's negative perceptions are distortions of reality or reflect a kernel of truth as compared to other sources of information including independent adult observers and age peers. Studies key to this question are those that investigate not only the social perceptions themselves but also the social behavior of socially anxious youth. Hence the selection of studies for the review was based on this criterion. From the relevant literature it is, as yet, unclear whether the negative interpretations of ambiguous social situations shown by socially anxious youth are distorted or a reflection of reality. Socially anxious youth's self-evaluations of social skills appear partly distorted and partly true, depending on the person judging the social skills. In contrast, self-evaluations of nervous behaviors appear distorted. The studies reviewed indicate that research would benefit from including a wider range of perceptions from persons relevant to the socially anxious youth's daily social environment, not only parents and teachers but also their age peers.

Age and puberty differences in stress responses during a public speaking task: do adolescents grow more sensitive to social evaluation?

During adolescence pubertal development is said to lead to an increase in general stress sensitivity which might create a vulnerability for the emergence of psychopathology during this period. However, the empirical evidence for increasing stress sensitivity is scarce and mixed. Biological responses (salivary cortisol and alpha-amylase) were investigated during a social-evaluative stressor, the Leiden Public Speaking Task, in 295 nine to 17-year olds. Specific attention was paid to different elements of the task, that is anticipation to and delivery of the speech. Biological reactivity to the speech task increased with age and puberty, particularly during anticipation. Current findings support the idea that biological stress sensitivity increases during adolescence, at least in response to a social-evaluative situation. The increasing stress sensitivity appears related to both age and pubertal maturation, but unique contribution could not be distinguished. The importance of measuring anticipation is discussed.

What motivates the adolescent? Brain regions mediating reward sensitivity across adolescence

The relation between brain development across adolescence and adolescent risky behavior has attracted increasing interest in recent years. It has been proposed that adolescents are hypersensitive to reward because of an imbalance in the developmental pattern followed by the striatum and prefrontal cortex. To date, it is unclear if adolescents engage in risky behavior because they overestimate potential rewards or respond more to received rewards and whether these effects occur in the absence of decisions. In this study, we used a functional magnetic resonance imaging paradigm that allowed us to dissociate effects of the anticipation, receipt, and omission of reward in 10- to 12-year-old, 14- to 15-year-old, and 18- to 23-year-old participants. We show that in anticipation of uncertain outcomes, the anterior insula is more active in adolescents compared with young adults and that the ventral striatum shows a reward-related peak in middle adolescence, whereas young adults show orbitofrontal cortex activation to omitted reward. These regions show distinct developmental trajectories. This study supports the hypothesis that adolescents are hypersensitive to reward and adds to the current literature in demonstrating that neural activation differs in adolescents even for small rewards in the absence of choice. These findings may have important implications for understanding adolescent risk-taking behavior.

Peer perceptions of social skills in socially anxious and nonanxious adolescents

Previous studies using adult observers are inconsistent with regard to social skills deficits in nonclinical socially anxious youth. The present study investigated whether same age peers perceive a lack of social skills in the socially anxious. Twenty high and 20 low socially anxious adolescents (13-17 years old) were recorded giving a 5-min speech. Unfamiliar peer observers (12-17 years old) viewed the speech samples and rated four social skills: speech content, facial expressions, posture and body movement, and way of speaking. Peer observers perceived high socially anxious adolescents as significantly poorer than low socially anxious adolescents on all four social skills. Moreover, for all skills except facial expressions, group differences could not be attributed to adolescents' self-reported level of depression. We suggest that therapists take the perceptions of same age peers into account when assessing the social skills of socially anxious youth.